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DR. SUMIT S. KAMBLE
DEPT. OF NEUROLOGY
Grading System for ranking recommendations in clinical
A Good evidence to support a recommendation for use
B Moderate evidence to support a recommendation for use
C Poor evidence to support a recommendation
Quality of evidence Definition
I Evidence from 1 properly randomized, controlled trial
II Evidence from 1 well-designed clinical trial, without
randomization; from cohort or case-controlled analytical
studies; from multiple time-series; or from dramatic results
from uncontrolled experiments
III Evidence from opinions of respected authorities, based on
clinical experience, descriptive studies, or reports of expert
1. Epidemiologic clues and assessment of risk factors to
identify potential etiologic agents should be sought in
all patients with encephalitis (A-III).
2. Clinical clues (general and specific neurologic
findings) may be helpful in suggesting certain
causative agents in patients with encephalitis (B-III).
3. In patients with encephalitis and a history of recent
infectious illness or vaccination, the diagnosis of
ADEM should be considered (B-III).
Possible etiologic agents of encephalitis based on
epidemiology and risk factors
Epidemiology or risk factor Possible infectious agent(s)
Agammaglobulinemia Enteroviruses, Mycoplasma pneumoniae
Neonates Herpes simplex virus type 2, cytomegalovirus,
rubella virus, Listeria monocytogenes, Treponema
pallidum, Toxoplasma gondii
Infants and children Eastern equine encephalitis virus, Japanese
encephalitis virus, Murray Valley encephalitis
virus, influenza virus, La Crosse
Elderly persons Eastern equine encephalitis virus, St. Louis
encephalitis virus, West Nile virus, sporadic CJD,
Bats Rabies virus, Nipah virus
Birds West Nile virus, Eastern equine encephalitis virus,
Western equine encephalitis virus, Venezuelan equine
encephalitis virus, St. Louis encephalitis virus, Murray
Valley encephalitis virus, Japanese encephalitis
virus, Cryptococcus neoformans (bird droppings)
Cats Rabies virus, Coxiella burnetii, Bartonella henselae, T.
Dogs Rabies virus
Horses Eastern equine encephalitis virus, Western equine
encephalitis virus,Venezuelan equine encephalitis
virus, Hendra virus
Raccoons Rabies virus, Baylisascaris procyonis
Rodents Eastern equine encephalitis virus (South America),
Venezuelan equine encephalitis virus, tickborne
encephalitis virus, Powassan virus
(woodchucks), La Crosse virus (chipmunks and
squirrels), Bartonella quintanab
Sheep and goats C. burnetii
Swine Japanese encephalitis virus, Nipah virus
Varicella zoster virus, cytomegalovirus, human herpesvirus
6, West Nile virus, HIV, JC virus, L. monocytogenes,
Mycobacterium tuberculosis, C. neoformans, Coccidioides
species, Histoplasma capsulatum, T. gondii
Raw meat T. gondii
Unpasteurized milk Tickborne encephalitis virus, L. monocytogenes, C. burnetii
Mosquitoes Eastern equine encephalitis virus, Western equine
encephalitis virus, Venezuelan equine encephalitis virus, St.
Louis encephalitis virus, Murray Valley encephalitis virus,
Japanese encephalitis virus, West
Nile virus, La Crosse virus, Plasmodium falciparum
Ticks Tickborne encephalitis virus, Powassan virus, Rickettsia
rickettsii, Ehrlichia chaffeensis, Anaplasma
phagocytophilum, C. burnetii (rare), B. burgdorfer
Sandflies Bartonella bacilliformis
Tsetse flies Trypanosoma brucei gambiense, Trypanosoma brucei
Laboratory workers West Nile virus, HIV, C. burnetii, Coccidioides species
Physicians and health
Varicella zoster virus, HIV, influenza virus, measles virus, M.
Veterinarians Rabies virus, Bartonella species, C. burnetii
Recent vaccination Acute disseminated encephalomyelitis
Herpes simplex virus (neonatal), varicella zoster virus,
Venezuelan equine encephalitis virus (rare), poliovirus,
nonpolio enteroviruses, measles virus, Nipah virus, mumps
virus, rubella virus, Epstein-Barr virus, human herpesvirus 6, B
virus, West Nile virus (transfusion, transplantation, breast
feeding), HIV, rabies virus (transplantation), influenza virus,
M. pneumoniae, M. tuberculosis, T. pallidum
Camping/hunting All agents transmitted by mosquitoes and ticks
Sexual contact HIV, T. pallidum
Swimming Enteroviruses, Naegleria fowleri
Late summer/early fall All agents transmitted by mosquitoes and ticks
Winter Influenza virus
Africa Rabies virus, West Nile virus, P. falciparum, T. brucei
gambiense, T. brucei rhodesiense
Australia Murray Valley encephalitis virus, Japanese encephalitis
virus, Hendra virus
Europe West Nile virus, tickborne encephalitis virus, A.
phagocytophilum, B. burgdorferi
India, Nepal Rabies virus, Japanese encephalitis virus, P. falciparum
Central America Rabies virus, Eastern equine encephalitis virus, Western equine
encephalitisvirus, Venezuelan equine encephalitis virus, St.
Louis encephalitis virus, R. rickettsii, P. falciparum, Taenia
South America Rabies virus, Eastern equine encephalitis virus, Western equine
encephalitis virus, Venezuelan equine encephalitis virus, St.
Louis encephalitis virus, R. rickettsii, B. bacilliformis (Andes
mountains), P. falciparum, T. solium
China, Pacific Rim
Japanese encephalitis virus, tickborne encephalitis virus, Nipah
virus, P. falciparum, Gnanthostoma species, T. solium
Cytomegalovirus, Epstein-Barr virus, West Nile virus, HIV,
tickborne encephalitis virus, rabies virus, iatrogenic CJD, T.
pallidum, A. phagocytophilum,
R. rickettsii, C. neoformans, Coccidioides species, H.
capsulatum, T. gondii
Varicella zoster virus, Japanese encephalitis virus, poliovirus,
measles virus, mumps virus, rubella virus
Possible etiologic agents of encephalitis based on
Clinical presentation Possible infectious agent
Hepatitis Coxiella burnetii
Lymphadenopathy HIV, Epstein-Barr virus, cytomegalovirus, measles
virus, rubella virus, West Nile virus, Treponema
pallidum, Bartonella henselae and other Bartonella
species, Mycobacterium tuberculosis, Toxoplasma
gondii, Trypanosoma brucei gambiense
Parotitis Mumps virus
Rash Varicella zoster virus, B virus, human herpesvirus 6,
West Nile virus, rubella virus, some enteroviruses, HIV,
Rickettsia rickettsii, Mycoplasma pneumoniae,
Borrelia burgdorferi, T. pallidum, Ehrlichia chaffeensis,
Retinitis Cytomegalovirus, West Nile virus, B. henselae, T.
Cerebellar ataxia Varicella zoster virus (children), Epstein-Barr virus,
mumps virus, St. Louis encephalitis virus,
Tropheryma whipplei, T. brucei gambiense
Cranial nerve abnormalities Herpes simplex virus, Epstein-Barr virus, Listeria
monocytogenes, M. tuberculosis, T. pallidum, B.
burgdorferi, T. whipplei, Cryptococcus neoformans,
Coccidioides species, H. capsulatum
Dementia HIV, human transmissible spongiform
encephalopathies (sCJD and vCJD),
measles virus (SSPE), T. pallidum, T. whipplei
Myorhythmia T. whipplei (oculomasticatory)
Japanese encephalitis virus, West Nile virus,
tickborne encephalitis virus; enteroviruses
(enterovirus-71, coxsackieviruses), poliovirus
Rhombencephalitis Herpes simplex virus, West Nile virus, enterovirus 71,
masked facies, cogwheel
rigidity, postural instability)
Japanese encephalitis virus, St. Louis encephalitis
virus, West Nile virus, Nipah virus, T. gondii, T. brucei
4. Specific diagnostic studies should be performed for
the majority of patients who present with encephalitis
5. Additional diagnostic studies should be performed
for patients with encephalitis on the basis of specific
epidemiologic and clinical clues (A-III).
Diagnostic Studies outside the CNS
6. Cultures of body fluid specimens (e.g., from blood, stool,
nasopharynx, or sputum), if clinical and epidemiologic clues
are suggestive, should be performed in an attempt to identify
various viral, bacterial, and fungal etiologies of encephalitis
(B-III); positive results do not necessarily indicate that
isolated microorganism is etiology of encephalitis and must
be interpreted in the context of the appropriate
epidemiologic findings, clinical findings, and other
diagnostic study results.
7. Biopsy of specific tissues for culture, antigen detection,
nucleic acid amplification tests (such as PCR), and
histopathologic examination should be performed in an
attempt to establish an etiologic diagnosis of encephalitis
8. Certain causes of encephalitis may be diagnosed by
detection of IgM antibodies in serum (A-III)
9. Although acute- and convalescent-phase serum samples
are generally not useful in establishing the etiology during
the acute presentation in a patient with encephalitis, they
may be useful for the retrospective diagnosis of an
infectious agent (B-III).
10. Nucleic acid amplification tests (such as PCR) of body
fluids outside of the CNS may be helpful in establishing
the etiology in some patients with encephalitis (B-III).
11. MRI is the most sensitive neuroimaging test to
evaluate patients with encephalitis (A-I).
12. CT, with and without contrast enhancement, should
be used to evaluate patients with encephalitis if MRI is
unavailable, impractical, or cannot be performed (B-
13. Fluorine-18 fluorodeoxyglucose positron emission
tomography (FDG-PET) scanning is not routinely
recommended for patients with encephalitis.
14. Electroencephalography (EEG) is rarely helpful in
establishing an etiology in patients with encephalitis,
but it has a role in identifying patients with
nonconvulsive seizure activity who are confused,
obtunded, or comatose and should be performed in all
patients with encephalitis (A-III).
15. CSF analysis is essential (unless contraindicated) in
all patients with encephalitis (A-III).
Diagnostic Studies in the CNS
16. For certain viral agents, the presence of virus-
specific IgM in CSF specimens may be indicative of
CNS disease caused by that pathogen (A-III).
17. Nucleic acid amplification tests (such as PCR)
should be performed on CSF specimens to identify
certain etiologic agents in patients with encephalitis
(A-III). Although a positive test result is helpful in
diagnosing infection caused by a specific pathogen, a
negative result cannot be used as definitive evidence
against the diagnosis.
18. Herpes simplex PCR should be performed on all CSF
specimens in patients with encephalitis (A-III). In patients
with encephalitis who have a negative herpes simplex PCR
result, consideration should be given to repeating the test
3–7 days later in those with a compatible clinical syndrome
or temporal lobe localization on neuroimaging (B-III).
19. Viral cultures of CSF specimens are of limited value in
patients with encephalitis and are not routinely
20. Brain biopsy should not be routinely used in patients
with encephalitis but should be considered in patients with
encephalitis of unknown etiology whose condition
deteriorates despite treatment with acyclovir (B-III).
Diagnostic evaluation to consider in determining the microbial
etiology in patients with encephalitis
General diagnostic evaluation
Viruses -Culture of respiratory secretions and nasopharynx, throat, and
-CSF PCR for cytomegalovirus, JC virus, human herpesvirus
6, and West Nile virus
-DFA of sputum for respiratory viruses
-PCR of respiratory specimens
-Culture and/or DFA of skin lesions (if present) for herpes simplex
virus and varicella zoster virus
-Serologic testing for HIV
-Serologic testing for Epstein-Barr virus
-Serologic testing for St. Louis encephalitis virus, Eastern equine
encephalitis virus, Venezuelan equine encephalitis virus, La Crosse
virus, West Nile virus
-CSF IgM for West Nile virus, St. Louis encephalitis virus, varicella
-CSF PCR for herpes simplex virus 1, herpes simplex virus 2,
varicella zoster virus, Epstein-Barr virus,d enteroviruses
Bacteria -Blood cultures
-CSF cultures …
-Serologic testing for Mycoplasma pneumoniae
-PCR of respiratory secretions for M. pneumoniae
Rickettsiae -Serologic testing for Rickettsia rickettsi, Ehrlichia chaffeensis, and
-DFA and PCR of skin biopsy specimen for R. rickettsiae
-Blood smears for morulae
-PCR of whole blood and CSF specimens for Ehrlichia and
Spirochetes -Serum RPR and FTA-ABS
-Serologic testing for Borrelia burgdorferi (ELISA and Western blot),
-CSF B. burgdorferi serologic testing (ELISA and Western blot);
-calculate IgG antibody index
Mycobacteria -Chest radiograph
-PCR and culture of respiratory secretions
-CSF AFB smear and culture
-CSF PCR (Gen-Probe Amplified Mycobacterium tuberculosis Direct
Fungi -Blood cultures
-Serum and CSF cryptococcal antigen
-Urine and CSF Histoplama antigeng
-Serum and CSF complement fixing or immunodiffusion antibodies
for Coccidioides species
Protozoa Serum IgG for Toxoplasma gondii
21. Acyclovir should be initiated in all patients with
suspected encephalitis, pending results of diagnostic
22. Other empirical antimicrobial agents should be
initiated on the basis of specific epidemiologic or clinical
factors , including appropriate therapy for presumed
bacterial meningitis, if clinically indicated (A-III).
23. In patients with clinical clues suggestive of rickettsial or
ehrlichial infection during the appropriate season,
doxycycline should be added to empirical treatment
24. Herpes simplex virus: acyclovir is recommended
25. Varicella-zoster virus: acyclovir is recommended
(BIII); ganciclovir can be considered an alternative (C-
III); adjunctive corticosteroids can be considered (C-III).
26. Cytomegalovirus: the combination of ganciclovir
plus foscarnet is recommended (B-III); cidofovir is not
recommended, because its ability to penetrate the
blood-brain barrier has been poorly studied.
27. Epstein-Barr virus: acyclovir is not
recommended; use of corticosteroids may be
beneficial (C-III), but the potential risks must be
weighed against the benefits.
28. Human herpesvirus 6: ganciclovir or foscarnet
should be used in immunocompromised patients (B-
III); use of these agents in immunocompetent patients
can be considered (CIII), but there are not good data
on their effectiveness.
29. B virus: valacyclovir is recommended (B-III);
alternative agents are ganciclovir (B-III) and acyclovir
30. Influenza virus: oseltamivir can be considered
31. Measles virus: ribavirin can be considered (C-III);
intrathecal ribavirin can be considered in patients with
subacute sclerosing panencephalitis (C-III).
32. Nipah virus: ribavirin can be considered (C-III).
33. West Nile virus: ribavirin is not recommended.
34. Japanese encephalitis virus: IFN-a is not
35. St. Louis encephalitis virus: IFN-2a can be considered
36. HIV: HAART is recommended (A-II).
37. JC virus: reversal of immunosuppression (A-III)—or
HAART in HIV-infected patients (A-II)—is recommended.
38. Bartonella bacilliformis: chloramphenicol,
ciprofloxacin, doxycycline, ampicillin, or trimethoprim-
sulfamethoxazole is recommended (B-III).
39. Bartonella henselae: doxycycline or azithromycin, with
or without rifampin, can be considered (C-III).
40. Listeria monocytogenes: ampicillin plus gentamicin is
recommended (A-III); trimethoprim-sulfamethoxazole is an
alternative in the penicillin-allergic patient (A-III).
41. Mycoplasma pneumoniae: antimicrobial therapy
(azithromycin, doxycycline, or a fluoroquinolone) can be
42. Tropheryma whipplei: ceftriaxone, followed by either
trimethoprim-sulfamethoxazole or cefixime, is
43. Mycobacterium tuberculosis: 4-drug
antituberculous therapy should be initiated (A-III);
adjunctive dexamethasone should be added in patients
with meningitis (B-I).
48. Borrelia burgdorferi: ceftriaxone, cefotaxime, or
penicillin G is recommended (B-II)
49. Treponema pallidum: penicillin G is
recommended (AII); ceftriaxone is an alternative (B-III).
Rickettsioses and ehrlichioses
44. Anaplasma phagocytophilum: doxycycline is
45. Ehrlichia chaffeensis: doxycycline is recommended
46. Rickettsia rickettsii: doxycycline is recommended
(AII); chloramphenicol can be considered an alternative in
selected clinical scenarios, such as pregnancy (C-III).
47. Coxiella burnetii: doxycycline plus a fluoroquinolone
plus rifampin is recommended (B-III).
50. Coccidioides species: fluconazole is recommended
(AII); alternatives are itraconazole (B-II), voriconazole (B-
III), and amphotericin B (intravenous and intrathecal) (C-
51. Cryptococcus neoformans: initial treatment with
amphotericin B deoxycholate plus flucytosine (A-I) or a
lipid formulation of amphotericin B plus flucytosine (A-II)
52. Histoplasma capsulatum: liposomal amphotericin B
followed by itraconazole is recommended (B-III).
53. Acanthamoeba: trimethoprim-sulfamethoxazole plus
rifampin plus ketoconazole (C-III) or fluconazole plus
sulfadiazine plus pyrimethamine (C-III) can be considered.
54. Balamuthia mandrillaris: pentamidine, combined
with a macrolide (azithromycin or clarithromycin),
fluconazole, sulfadiazine, flucytosine, and a phenothiazine
can be considered (C-III).
55. Naegleria fowleri: amphotericin B (intravenous and
intrathecal) and rifampin, combined with other agents, can
be considered (C-III).
56. Plasmodium falciparum: quinine, quinidine, or
artemether is recommended (A-III); atovaquone-proguanil
is an alternative (B-III); exchange transfusion is
recommended for patients with 110% parasitemia or
cerebral malaria (B-III); corticosteroids are not
57. Toxoplasma gondii: pyrimethamine plus either
sulfadiazine or clindamycin is recommended (A-I);
trimethoprimsulfamethoxazole alone (B-I) and
pyrimethamine plus either atovaquone, clarithromycin,
azithromycin, or dapsone (B-III) are alternatives.
58. Trypanosoma brucei gambiense: eflornithine is
recommended (A-II); melarsoprol is an alternative (A-II).
59. Trypanosoma brucei rhodesiense: melarsoprol is
60. Baylisascaris procyonis: albendazole plus
diethycarbamazine can be considered (C-III);
adjunctive corticosteroids should also be considered
61. Gnathostoma species: albendazole (B-III) or
ivermectin (B-III) is recommended.
62. Taenia solium: need for treatment should be
individualized; albendazole and corticosteroids are
recommended (BIII); praziquantel can be considered
as an alternative (C-II).
63. Acute disseminated encephalomyelitis: high-
dose corticosteroids are recommended (B-III);
alternatives include plasma exchange (B-III) and
intravenous immunoglobulin (CIII).
GUIDELINES CLINICAL MANAGEMENT OF ACUTE
ENCEPHALITIS SYNDROME INCLUDING
GOVERNMENT OF INDIA
National Vector Borne Disease Control Programme
Directorate General of Health Services,
Ministry of Health & Family Welfare
Case definition of Acute Encephalitis Syndrome
(AES)-defined as a person of any age, at any time of
year with acute onset of fever and a change in mental
status (including symptoms such as confusion,
disorientation, come, or inability to talk) AND/OR
new onset of seizures(excluding simple febrile
a) Laboratory-confirmed JE: A suspected case that has
been laboratory-confirmed as JE.
b) Probable JE: A suspected case that occurs in close
geographic and temporal relationship to laboratory-
confirmed case of JE, in the context of an outbreak.
c) .Acute encephalitis syndrome. (due to agent other than
JE): A suspected case in which diagnostic testing is
performed and an etiological agent other than JE virus is
d) .Acute encephalitis syndrome. (due to unknown agent )
A suspected case in which no diagnostic testing is
performed or in which testing was performed but no
etiological agent was identified or in which the test results
AGENTS OF CLINICALLY IMPORTANT VIRAL ENCEPHALITIS IN
Japanese encephalitis virus
• Outbreak-2006, east UP (EV
89,76); 2008, Lucknow (EV 71)
• Sporadic-2004-06, AMU, UP
(EV 71); 2007, Delhi (EV 71)
Herpes simplex virus 1 (HSV-1)
Dengue Virus (encephalopathy)
• Outbreak-Andhra Pradesh
2003; Gujarat 2004; Nagpur
2005; Nagpur 2007
• Sporadic-2005-06; Andhra
Varicella zoster virus (VZV)
Epstein-Barr virus (EBV)
Human immunodeficiency virus
Human herpesvirus 6 (HHV-6)
• Outbreak: 2001, Siliguri; 2007,
West Nile virus
Kyasanur Forest Disease
MRI FINDINGS IN VIRAL ENCEPHALITIS AND SOME MIMICKERS
Etiology MRI Finding
Herpes simplex encephalitis Abnormal signal intensity in medial temporal lobe,
cingulate gyrus, and orbital surface
of frontal lobes
Japanese B encephalitis Abnormal signal intensity in thalami (87-94%),
substantia nigra, and basal ganglia
EV 71 Abnormal signal intensity in the dorsal pons,
medulla, midbrain, and dentate nuclei of
the cerebellum; gigh-signal lesions can also be
found in the anterior horn cells of spinal
cord in patients with acute flaccid paralysis
Chandipura virus Normal
Nipah virus Focal subcortical and deep white matter and gray
matter lesions; small hyperintense
lesions in the white matter, cortex, pons and
cerebral peduncles have also been seen.
Varicella Multifocal abnormalities in cortex, associated
cerebellitis, vasculitis and vasculopathy
Multifocal abnormalities in subcortical white
matter; involvement of thalami, basal
ganglia, and brainstem also seen
West Nile virus Abnormalities in deep gray matter and brainstem
(50%); white matter lesions
mimicking demyelination may also be seen;
meningeal involvement on contrast
GUIDELINES FOR COLLECTION, STORAGE AND TRANSPORT OF SAMPLES
Type of sample Guidelines
Blood • Collect within 4 days after the onset of illness for isolation of
virus and at least 5 days after the onset of
illness for detection of IgM antibodies.
• A second, convalescent sample should be collected at least 10-14
days after the first sample for serology.
• Take clotted blood sample. Separate serum after clot retraction.
• Serum should be shipped on wet ice within 48 hours or stored at
for a maximum period of 7 days.
• In case a delay is anticipated, sera must be frozen at -20°C and
should be transported to the specified
laboratory on frozen ice packs.
• Repeated freezing and thawing can have detrimental effects on
the stability of IgM antibodies.
• Send for cell count, bacteriology, biochemistry and virology -
• May be stored at +4°C if delays in processing for virus culture or
viral PCR will be less than 24 hrs.
• If greater delays are likely, CSF should be frozen at -80°C.
Swabs (naso-phary-geal, throat,
• Dacron/ Nylon swabs should be used, and put
into virus transport medium. Swabs may be
utilized for a range of virus cultures and PCR.
Urine 10-20 mL of urine should be collected into
sterile containers (without preservatives) for
mumps virus culture and
mumps PCR; store at -20°C.
Stool Stool should be collected for enterovirus
culture into clean containers; store at -20°C.
Brain biopsy • Brain specimens should be collected unfixed
into a sterile container. Brain smears can be
used for viral
antigen detection by immunofluorescent
antibody staining, and for electron microscopy
• Emulsified brain tissue is suitable for tissue
culture and after proteinase K treatment for
MICROBIOLOGICAL INVESTIGATIONS AVAILABLE IN ACUTE ENCEPHALITIS
Virus Sample/ test
Japanese Encephalitis Virus Virus-specific IgM antibody in a single sample of
cerebrospinal fluid (CSF) or serum, as detected by
an IgM-capture ELISA specifically for JE virus
Enteroviral encephalitis -Detection of EV genome by RT-PCR or an equally
sensitive and specific nucleic acid amplification
test (real time) in CSF
-Isolation of virus from serum/stool/throat swab
Dengue viral encephalitis Dengue virus-specific IgM antibody in a single
sample of CSF as detected by an IgM-capture
HSV Encephalitis -Detection of HSV DNA in CSF by PCR
-HSV specific antibody titres in serum and CSF
Mumps virus encephalitis Detection of Mumps virus RNA in CSF by PCR
Varicella zoster virus
Detection of VZV DNA by PCR in CSF
Nipah virus -Detection of Nipah virus specific IgM antibodies in
serum and CSF by IgM-capture ELISA
-PCR from CSF
Measles virus Appearance of measles virus specific IgM antibody in
Chandipura virus -PCR from CSF
-Detection of specific IgM antibodies in CSF by ELISA
Basic investigations in suspected AES-
Complete blood count (including platelet count),
blood glucose, serum electrolytes, liver and kidney
function tests, blood culture, arterial blood gas.
Peripheral smear for malarial parasite and rapid
diagnostic test for malaria .
CSF should be examined for cytology, biochemistry,
gram stain, Ziehl-Nielsen stain for acid fast bacilli,
bacterial culture, PCR for HSV 1 and 2, and IgM
antibodies for JE and for Dengue virus (if suspected).
Concurrent blood sugar must also be measured .
1-2 Ml CSF should be stored for other virological
studies, if needed.
(i) Surveillance for cases of AES;
(ii) Vector control;
(iii) Reduction in man-vector contact;
Although vaccines are under development against
many viral agents responsible for AES in children, but
primarily it is JE against which vaccines are available
for routine use.
Cell culture-derived, live attenuated vaccine:
Currently, this is the only JE vaccine available in India.
0.5 mL dose is to be administered subcutaneously to
children at eight months of age and a second at two
Association of British Neurologists and British Infection Association National Guidelines